Tag Archive for: Dr. Matthew Strickland

Should Gastric Cancer Patients Be Treated Immediately?

Should Gastric Cancer Patients Be Treated Immediately? from Patient Empowerment Network on Vimeo.

Is it critical that gastric cancer therapy begin immediately? Expert Dr. Matthew Strickland explains how timing can affect care and key factors to consider when deciding on a treatment plan.

Dr. Matthew Strickland is a medical oncologist at Massachusetts General Hospital. Learn more about Dr. Strickland.

See More From INSIST! Gastric Cancer

Related Programs:

How Is Gastric Cancer Biomarker Testing Conducted?

How Is Gastric Cancer Biomarker Testing Conducted?

Should Gastric Cancer Patients Consider a Second Opinion?

Should Gastric Cancer Patients Consider a Second Opinion?

How Do Biomarker Test Results Impact a Gastric Cancer Treatment Plan?

How Do Biomarker Test Results Impact a Gastric Cancer Treatment Plan?


Transcript:

Katherine Banwell:

Dr. Strickland, if I’ve been recently diagnosed, how long is it safe for me to wait before I begin treatment? 

Dr. Matthew Strickland:

I’m so glad you asked that question, because this is a question that comes up nearly 100 percent of the time when I meet a patient for the first time. Understandably once someone is diagnosed, this leads to incredible anxiety to start to do something. It’s true that over a long period of time cancer could develop the ability to spread, but what’s I’m often telling my patients is that on the order of 2, 3, or perhaps 4 weeks, that’s not enough time for cancer to spread.  

It’s much more important for us to complete a proper workup, so we know in great detail what diagnosis we’re dealing with as well as what stage we’re dealing with.  

That we can prepare the most personalized treatment plan for that patient. So, it’s very common for us to start treatment, you know, two to three weeks after that initial meeting. I want patients to really know that this is okay. Nothing is going to change compared to that original diagnosis in that short period of time.  

Should Gastric Cancer Patients Consider a Second Opinion?

Should Gastric Cancer Patients Consider a Second Opinion? from Patient Empowerment Network on Vimeo.

What should gastric cancer patients seek a second opinion? Expert Dr. Matthew Strickland explains potential benefits of a second opinion when facing a gastric cancer diagnosis. 

Dr. Matthew Strickland is a medical oncologist at Massachusetts General Hospital. Learn more about Dr. Strickland.

See More From INSIST! Gastric Cancer

Related Programs:

How Is Gastric Cancer Biomarker Testing Conducted?

How Is Gastric Cancer Biomarker Testing Conducted?

Essential Testing Following a Gastric Cancer Diagnosis

Essential Testing Following a Gastric Cancer Diagnosis

How Do Biomarker Test Results Impact a Gastric Cancer Treatment Plan?

How Do Biomarker Test Results Impact a Gastric Cancer Treatment Plan?


Transcript:

Katherine Banwell:

Dr. Strickland, why is it beneficial for patients to seek a second opinion at a comprehensive cancer center?  

Dr. Matthew Strickland:

I’m very glad you asked this question, because there is often a disconnect that I’ve noticed. As providers, we really love second opinions or beyond. Third opinions, you name it. The disconnect that I’m talking about is often patients are a little bit shy or perhaps sheepish in telling me or asking should I get a second opinion. From the provider perspective, treating cancer is a tough business. New data is coming out all the time.  

You never know what center might have a clinical trial option that perhaps your center might not have. I would say that 99 percent of the time everyone is on the same team and looking to find the best treatment option for the patient. Again, I really can’t even think of a negative interaction I’ve had with fellow providers at different institutions. I really believe that this is a community that wants the best for the patient. So, I highly encourage at all times a second opinion or beyond.  

How Do Biomarker Test Results Impact a Gastric Cancer Treatment Plan?

How Do Biomarker Test Results Impact a Gastric Cancer Treatment Plan? from Patient Empowerment Network on Vimeo.

What impact do biomarker test results have on gastric cancer care? Expert Dr. Matthew Strickland explains how the identification of biomarkers affect treatment choices and why patients should insist on this essential testing. 

Dr. Matthew Strickland is a medical oncologist at Massachusetts General Hospital. Learn more about Dr. Strickland.

See More From INSIST! Gastric Cancer

Related Programs:

How Is Gastric Cancer Biomarker Testing Conducted?

How Is Gastric Cancer Biomarker Testing Conducted?

Should Gastric Cancer Patients Consider a Second Opinion?

Should Gastric Cancer Patients Consider a Second Opinion?

Should Gastric Cancer Patients Be Treated Immediately?

Should Gastric Cancer Patients Be Treated Immediately?


Transcript:

Katherine Banwell:

Dr. Strickland, how do biomarker test results impact gastric cancer prognosis?  

Dr. Matthew Strickland:

So, biomarkers will directly guide our treatment decisions in how we can assemble the best treatment plan for our patient as an individual. That will have direct ramifications for how well and for how long that therapy can work for.  

So, I would say that there’s a direct correlation between the biomarker analysis to prognosis.  

Katherine Banwell:

Dr. Strickland, how do biomarker test results impact gastric cancer treatment options?  

Dr. Matthew Strickland:

So, for example, depending on the stage…if a patient has a stage IV cancer, PD-L1 expression will guide our treatment decision whether to include immunotherapy typically with a chemotherapy background or not. To say that a different way, if the expression is very low or absent, we know that patient likely will not benefit from immunotherapy and could actually be harmed, because there is some toxicity that comes with these treatments. That’s one example. But similarly for HER2+ patients, we’ll similarly assemble a treatment regimen with a targeted therapy that is included.  

That certainly guides treatment options, specifically based on a HER2-positive result or negative. The next biomarker I want everyone to know about is called PD-L1. That stands for programmed death ligand 1. This is also a protein that’s expressed on the surface of cancer cells.  

That usually leads to a better outcome than for patients that we can’t include a targeted therapy and left relying on chemotherapy only.  

Katherine Banwell:

Dr. Strickland, what questions should patients ask their healthcare team about testing and test results?  

Dr. Matthew Strickland:

Because biomarker status is so critical for treatment decisions and leading to outcomes and prognosis, I would encourage patients to ask their provider if all standard biomarkers have been obtained at the time of their diagnosis. Sometimes that answer is no, but they’re working on it. That’s okay. But I would highly encourage patients to just ensure that standard biomarkers are being tested for, that they will directly guide the treatment recommendations.  

Katherine Banwell:

Dr. Strickland, is there developing research or treatment news that gastric cancer patients should know about?  

Dr. Matthew Strickland:

I think it’s a very exciting time for the treatment of gastric cancer. Now, we still have a lot of work to do. I don’t want to minimize. This is still a tough and can be an aggressive cancer. It’s no time to let up.   

That being said, if we use immunotherapy as an example alone, there’s been a flurry of new approvals for standard of care in the last three to four years. Our understanding is only increasing of how to select the right patients that will benefit as well as how to avoid some of the toxicities. Beyond immunotherapy, there are new and emerging targets that we can design targeted therapy for.  

We don’t yet have mainstream approvals for targets like Claudin 18.2. But this is a very exciting new target that I think will lead to an approval in the short future.  

How Is Gastric Cancer Biomarker Testing Conducted?

How Is Gastric Cancer Biomarker Testing Conducted? from Patient Empowerment Network on Vimeo.

Biomarker testing is essential for gastric cancer patients, but how is it conducted? Expert Dr. Matthew Strickland explains the methods of biomarker testing and the common biomarkers associated with gastric cancer.

Dr. Matthew Strickland is a medical oncologist at Massachusetts General Hospital. Learn more about Dr. Strickland.

See More From INSIST! Gastric Cancer

Related Programs:

Expert Advice for Newly Diagnosed Gastric Cancer Patients

Expert Advice for Newly Diagnosed Gastric Cancer Patients

Essential Testing Following a Gastric Cancer Diagnosis

Essential Testing Following a Gastric Cancer Diagnosis

What Is Gastric Cancer?

What Is Gastric Cancer?


Transcript:

Katherine Banwell:

So, how is biomarker testing conducted? Is it via a blood test?  

Dr. Matthew Strickland:

This is also an excellent question. Biomarkers can often be tested in different ways. Most of the biomarkers that I’ve outlined start by being tested via cell surface expression of those proteins. Basically, that translates to once the biopsy of the tumor is taken out and is now in the pathology lab, a pathologist can apply different stains to identify these proteins and biomarkers.  

Then, they can assess, in other words, quantify the level of expression. This method is called immunohistochemistry. I would say it’s a fair statement to think this is a first pass method of detecting biomarkers.  

But it’s not the only one. Beyond that…there’s, for example, HER2 can sometimes reflex to assessing the copy number of the gene. So, we’re no longer talking at the protein level. Right now, we’re talking about using a method…the acronym is FISH, which stands for fluorescence in situ hybridization. This is a method to quantify the number of copies of the gene.  

If the cancer has indeed overexpressed HER2 to gain a growth advantage, then often we’ll see a very significantly high copy number. Then, to address your question regarding biomarkers detected in the blood, this is also a new area, relatively new. We know that there are fairly effective tools to test for circulating tumor DNA.   

Backing up for a moment, cancer cells can – let me rephrase. Cancer cells will to some degree shed their DNA into the bloodstream. We are able to detect that unique DNA to some degree. So, these tools, which are generally called circulating tumor DNA assays, there are different companies. The names of their products can be different. But they’re becoming increasingly effective at detecting tumor DNA in the blood.  

So, there are several approvals for these tools. But this can get a little bit tricky. Because the tools are so new, they’re not yet integrated into our standard management. So, perhaps, at larger cancer centers you might see providers utilizing these tools, but it might not be offered at every location.  

Essential Testing Following a Gastric Cancer Diagnosis

Essential Testing Following a Gastric Cancer Diagnosis from Patient Empowerment Network on Vimeo.

What testing should newly diagnosed gastric cancer patients undergo? Expert Dr. Matthew Strickland discusses what is analyzed in biomarker testing and how immunotherapy works against cancer.

Dr. Matthew Strickland is a medical oncologist at Massachusetts General Hospital. Learn more about Dr. Strickland.

See More From INSIST! Gastric Cancer

Related Programs:

How Do Biomarker Test Results Impact a Gastric Cancer Treatment Plan?

How Do Biomarker Test Results Impact a Gastric Cancer Treatment Plan?

Should Gastric Cancer Patients Consider a Second Opinion?

Should Gastric Cancer Patients Consider a Second Opinion?

Should Gastric Cancer Patients Be Treated Immediately?

Should Gastric Cancer Patients Be Treated Immediately?


Transcript:

Katherine Banwell:

Dr. Strickland, what biomarker testing is standard following a gastric cancer diagnosis?  

Dr. Matthew Strickland:

This is a very active area both for approved targets as well as from a research side of things. We’re trying to discover new biomarkers. I think it’s a critically important question. There are really three major biomarkers to help us make conventional treatment decisions. I’ll list them off first. Then, perhaps, I’ll break them down. The first is HER2. That’s H-E-R-2. Typically, folks have heard of this biomarker who are more in the cancer.  

But the truth is that the same molecular alteration happens at a relatively high frequency for gastric cancer. It’s a critically important biomarker because if we determine that the tumor is HER2-positive, what this tells us is that the cancer is thriving based on this protein in the signaling machinery downstream of this protein. The reason we like to know that is we can then target it as a vulnerability of that cancer.  

That certainly guides treatment options, specifically based on a HER2-positive result or negative. The next biomarker I want everyone to know about is called PD-L1. That stands for programmed death ligand 1. This is also a protein that’s expressed on the surface of cancer cells.  

What we’ve come to understand is that high expression of this protein will interact with immune cells in such a way that it tells immune cells to turn the dial down on their activity. From the cancer cell standpoint, this is a very clever mechanism. Because in normal circumstances, our immune system actually can detect cancer and eliminate it to some degree.  

However, when cancer cells choose, if you will, to overexpress this protein on their surface, it can act as a cloak. Suddenly, the immune system can no longer effectively detect and, of course, attack that cancer cell. This is critically important to know because if indeed a cancer cell is using this mechanism to survive, then we can also take advantage of this vulnerability. 

We can add various immunotherapy therapeutics to the treatment plan. The last biomarker of three that I think up front are very important to know about is called mismatch repair status. Mismatch repair proteins are important proteins that we have in all of our cells. Nature basically gave us these proteins to fix small mistakes in the DNA replication.  

That is to say when we’re growing and cells are dividing, DNA, which is the blueprint for our healthy cells, is copied. There’s a very low rate of mistakes, but there is a constant rate of mistakes. So, nature gave us what are called mismatch repair proteins that literally sit on the back of the enzymes that are doing the work.  

They can detect mistakes; they can snip out those mistakes. They can reinsert the right base pairs to fix the proper DNA code. Now, if these proteins are lost or their function is impaired, this can be advantageous to a cancer cell. The reason is mutations and mistakes will pile up, and they don’t get corrected. This can lead to certain growth advantages for the cancer.  

We know that gastric cancer at a relatively high frequency will utilize this mechanism to propagate itself. So, again, by knowing that the cancer is relying on this mechanism, we can directly take advantage of this as a vulnerability. We can improve the outcomes for the patients through their treatment. 

Expert Advice for Newly Diagnosed Gastric Cancer Patients

Expert Advice for Newly Diagnosed Gastric Cancer Patients from Patient Empowerment Network on Vimeo.

What should newly diagnosed gastric cancer patients know about their care? Expert Dr. Matthew Strickland discusses essential members of the gastric cancer care team.

Dr. Matthew Strickland is a medical oncologist at Massachusetts General Hospital. Learn more about Dr. Strickland.

See More From INSIST! Gastric Cancer

Related Programs:

What Is Gastric Cancer?

What Is Gastric Cancer?

Essential Testing Following a Gastric Cancer Diagnosis

Essential Testing Following a Gastric Cancer Diagnosis

Should Gastric Cancer Patients Be Treated Immediately?

Should Gastric Cancer Patients Be Treated Immediately?


Transcript:

Katherine Banwell:

What advice would you give people who have recently been diagnosed with gastric cancer?   

Dr. Matthew Strickland:

I really appreciate that question.  

Even though I spend all of my day job taking care of patients with these cancers, I’m never really there with them when they get the news. Often, they’re told by their primary care physician or the gastroenterologist that may have done the scope that led to the original diagnosis. I would say it’s the minority of time where I’m breaking the news. I think that there’s a lot of things to say to the patient.  

But one of the most important things I would want patients to know is that there is a whole army of people that are ready to help you if you get this scary news. It certainly doesn’t seem like that at first, and you don’t know who to call. But if you can call your closest cancer center and try to get into what we call a multidisciplinary meeting – what that means is you might see a medical oncologist, a surgeon, perhaps a radiation oncologist.  

The point here is that as soon as you pick up the phone and get that appointment, the machinery is going to start working for you, so we can help you.   

What Is Gastric Cancer?

What Is Gastric Cancer? from Patient Empowerment Network on Vimeo.

Are gastric cancer and stomach cancer one and the same? Expert Dr. Matthew Strickland defines gastric cancer and provides an overview of subtypes.

Dr. Matthew Strickland is a medical oncologist at Massachusetts General Hospital. Learn more about Dr. Strickland.

See More From INSIST! Gastric Cancer

Related Programs:

Expert Advice for Newly Diagnosed Gastric Cancer Patients

Expert Advice for Newly Diagnosed Gastric Cancer Patients

Essential Testing Following a Gastric Cancer Diagnosis

Essential Testing Following a Gastric Cancer Diagnosis

How Is Gastric Cancer Biomarker Testing Conducted?

How Is Gastric Cancer Biomarker Testing Conducted?


Transcript:

Katherine Banwell:

I’d like to start with a basic definition. What is gastric cancer? Is it the same as stomach cancer?  

Dr. Matthew Strickland:

So, I think that’s a great question. I think for most of us from the patient perspective, just the word “cancer” is very scary. It can instantly stimulate a variety of emotions that all hit at once. So, I’d be happy to try to break that down. At the fundamental level, a cancer cell is a cell that originated as a healthy, normal cell in the body. Then, due to acquired genetic mutations or other aberrations have decided to stop playing by the rules and start growing out of control.   

So, if this happens in the stomach, which, of course, is an anatomic location, that could be considered a stomach cancer. But beyond that, there can be different subtypes. I would say the most common type is what we call adenocarcinoma.  

This is the aggressive kind. This is what I see most of the time and treat. But there are other types of tumors that could originate in the stomach such as a neuroendocrine tumor or perhaps even a lymphoma. Sometimes, we see tumors that are called gastrointestinal stromal tumors. So, I just want to make the point that there are a variety of different cancers that can originate in the stomach. But most of the time, folks are thinking of adenocarcinoma.  

Then, to also answer your question specifically, gastric cancer and stomach, they’re probably interchangeable terms. But, of course, it’s important to determine the subtype.